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Cost of hospitalised patients due to complicated urinary tract infections: a retrospective observational study in countries with high prevalence of multidrug-resistant Gram-negative bacteria: the COMBACTE-MAGNET, RESCUING study
  1. Laura Vallejo-Torres1,2,
  2. Miquel Pujol3,4,
  3. Evelyn Shaw3,4,
  4. Irith Wiegand5,
  5. Joan Miquel Vigo6,
  6. Margaret Stoddart7,
  7. Sally Grier7,
  8. Julie Gibbs7,
  9. Christiane Vank5,
  10. Nienke Cuperus8,
  11. Leo van den Heuvel8,
  12. Noa Eliakim-Raz9,10,
  13. Jordi Carratala3,4,
  14. Cuong Vuong5,
  15. Alasdair MacGowan7,
  16. Tanya Babich9,10,
  17. Leonard Leibovici9,10,
  18. Ibironke Addy5,
  19. Stephen Morris1
  20. on behalf of RESCUING Study Group and Study Sites
    1. 1 UCL Department of Applied Health Research, University College London, London, UK
    2. 2 Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
    3. 3 Infectious diseases Department, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
    4. 4 Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
    5. 5 AiCuris Anti-infective Cures GmbH, Wuppertal, Germany
    6. 6 Informatics Unit, Fundació Institut Català de Farmacologia, Barcelona, Spain
    7. 7 Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
    8. 8 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
    9. 9 Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
    10. 10 Sackler Faculty of Medicine, Tel-Aviv University, Petah Tikva, Israel
    1. Correspondence to Dr Laura Vallejo-Torres; laura.vallejotorres{at}


    Objective Complicated urinary tract infections (cUTIs) impose a high burden on healthcare systems and are a frequent cause of hospitalisation. The aims of this paper are to estimate the cost per episode of patients hospitalised due to cUTI and to explore the factors associated with cUTI-related healthcare costs in eight countries with high prevalence of multidrug resistance (MDR).

    Design This is a multinational observational, retrospective study. The mean cost per episode was computed by multiplying the volume of healthcare use for each patient by the unit cost of each item of care and summing across all components. Costs were measured from the hospital perspective. Patient-level regression analyses were used to identify the factors explaining variation in cUTI-related costs.

    Setting The study was conducted in 20 hospitals in eight countries with high prevalence of multidrug resistant Gram-negative bacteria (Bulgaria, Greece, Hungary, Israel, Italy, Romania, Spain and Turkey).

    Participants Data were obtained from 644 episodes of patients hospitalised due to cUTI.

    Results The mean cost per case was €5700, with considerable variation between countries (largest value €7740 in Turkey; lowest value €4028 in Israel), mainly due to differences in length of hospital stay. Factors associated with higher costs per patient were: type of admission, infection source, infection severity, the Charlson comorbidity index and presence of MDR.

    Conclusions The mean cost per hospitalised case of cUTI was substantial and varied significantly between countries. A better knowledge of the reasons for variations in length of stays could facilitate a better standardised quality of care for patients with cUTI and allow a more efficient allocation of healthcare resources. Urgent admissions, infections due to an indwelling urinary catheterisation, resulting in septic shock or severe sepsis, in patients with comorbidities and presenting MDR were related to a higher cost.

    • urinary tract infections
    • cost of illness
    • health economics

    This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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    • Contributors Conceptualisation: all authors; acquisition of data: all authors; analysis of data: LVT, MP, ES, LL and SM; writing – original draft preparation: LVT, MP, ES, LL and SM; writing – review and editing: all authors; agree with manuscript results and conclusions: all authors.

    • Funding This research project receives support from the Innovative Medicines Initiative Joint Undertaking under grant agreement n° 115523, 115620, 115737 resources of which are composed of financial contribution from the European Union Seventh Framework Programme (FP7/2007-2013) and EFPIA companies in kind contribution. The research leading to these results was conducted as part of the COMBACTE-MAGNET consortium. For further information please refer to

    • Competing interests Within the IMI project, AiCuris provided support for the institutions of the following Researchers: LVT, MP, ES, JMV, MS, SG, JG, NC, LH, NE-R, JC, AM, TB, LL and SM. IW, ChV, CuV and IA are employees of AiCuris Anti-infective Cures GmbH, an EFPIA (European Federation of Pharmaceutical Industries and Association) member in the IMI JU. Costs related to the research contribution by IW, ChV, CuV and IA are borne by AiCuris Anti-infective Cures GmbH and considered in-kind contribution under the IMI JU scheme.

    • Patient consent Not required.

    • Ethics approval Local Ethics Committees of Research in each participating site.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data available.

    • Collaborators RESCUING Study Group and Study Sites principal investigators: Dora Tancheva, Rossitza Vatcheva-Dobrevska, Sotirios Tsiodras, Emmanuel Roilides, Istvan Várkonyi, Judit Bodnár, Aniko Farkas, Mical Paul, Yehuda Carmeli, Emanuele Durante Mangoni, Cristina Mussini, Nicola Petrosillo, Andrei Vata, Adriana Hristea, Julia Origüen, Jesus Rodriguez-Baño, Arzu Yetkin and Nese Saltoglu.

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